Sleep is one of the foundations of how we feel and function. A good night’s sleep supports attention, memory, emotional regulation and physical recovery, while poor sleep can leave us feeling mentally slower, less energetic and more emotionally reactive. Because sleep and mental health are closely connected, researchers have increasingly asked whether the effects of TMS may extend beyond mood to sleep itself.
Sleep and mood are closely connected
Sleep disturbance is common in major depressive disorder, which makes the relationship difficult to untangle. If depression improves and sleep also improves, the sleep change could simply reflect overall recovery. Collins et al. specifically examined this question in patients receiving a course of 10-Hz left-DLPFC rTMS. [1]
In that study, both mood and Pittsburgh Sleep Quality Index scores improved after treatment. Importantly, changes in sleep quality were not correlated with changes in depressive symptoms, even after adjustment for factors including age, sex, sedative-hypnotic use, number of TMS treatments and depression severity. This suggests that the two outcomes did not necessarily change together, but the small sample and absence of a control group prevent firm conclusions about a direct effect of rTMS on sleep independent of mood. [1]
Falling asleep and staying asleep
Chen et al. studied 136 adults with major depression receiving medication together with either active or sham bilateral DLPFC rTMS. Active stimulation was associated with greater improvement in the sleep-disorder factor of the Hamilton Depression Rating Scale, including sleep onset, middle-of-the-night awakening and early awakening. The study also examined the hypothalamic-pituitary-adrenal (HPA) axis, creating an interesting link between sleep and the biology of stress regulation. [2]
What does broader literature show?
A 2025 systematic review and meta-analysis by Liu et al. examined randomized controlled trials of rTMS in people with more-than-mild depressive mood. Across 11 studies involving 548 participants, rTMS was associated with greater improvement in sleep quality than control conditions. Another 2025 systematic review by Ma et al., focused on rTMS combined with pharmacological treatment in depression, included 17 randomized controlled trials and 1,667 participants and likewise reported improvement in sleep quality and depressive symptoms. [3,4]
These studies differ in stimulation frequency, treatment duration, medication background and patient characteristics. They therefore do not establish one optimal TMS protocol for sleep, and most of the evidence comes from clinical populations rather than healthy people seeking better rest. [3,4]
Sleep, stress, mood and the adaptable brain
Sleep interacts with the same broader systems that shape mood, stress regulation, cognition and emotional control. At the same time, sleep is important for learning, memory and plasticity. This makes it an especially interesting part of the broader TMS story.
Repetitive TMS can induce changes in cortical excitability that persist after stimulation has ended. Neuroplasticity offers one framework for understanding how repeated modulation of a network might gradually influence functions beyond the immediate stimulation period. It should not, however, be interpreted as proof that neuroplasticity itself directly improves sleep. [5]
The strongest current sleep evidence comes from depression and related clinical populations. It cannot simply be extrapolated to healthy people with occasional poor sleep. Still, the finding that sleep can improve during TMS treatment and may in some cases change independently of mood adds another important piece to the picture of how brain stimulation can influence interconnected aspects of how people feel and function. [1-4]
References
[1] Collins AR, Cheung J, Croarkin PE, Kolla BP, Kung S. Effects of transcranial magnetic stimulation on sleep quality and mood in patients with major depressive disorder. J Clin Sleep Med. 2022; 18(5):1297-1305. doi:10.5664/jcsm.9846.
[2] Chen X, Jiang F, Yang Q, et al. Bilateral repetitive transcranial magnetic stimulation ameliorated sleep disorder and hypothalamic-pituitary-adrenal axis dysfunction in subjects with major depression. Front Psychiatry. 2022; 13:951595. doi:10.3389/fpsyt.2022.951595.
[3] Liu Y, Huang S, Zhang X, et al. The effect of repetitive transcranial magnetic stimulation on sleep quality in patients with more than mild depressive mood: a systematic review and meta-analysis. Front Psychiatry. 2025; 16:1511930. doi:10.3389/fpsyt.2025.1511930.
[4] Ma X, Liu C, Wang P, et al. A Systematic Review of the Effects of Repetitive Transcranial Magnetic Stimulation Combined With Pharmacological Intervention on Sleep Quality and Depressive Symptoms in Patients With Depression. Stress Health. 2025; 41(2):e70041. doi:10.1002/smi.70041.
[5] Hoogendam JM, Ramakers GMJ, Di Lazzaro V. Physiology of repetitive transcranial magnetic stimulation of the human brain. Brain Stimul. 2010; 3(2):95-118. doi:10.1016/j.brs.2009.10.005.
